Detection and evaluation of chronic kidney disease. Am Fam Physician

pproximately 19 million Amer-icans older than 20 years have chronic kidney disease, and an additional 435,000 have end-stage renal disease (Table 11). The incidence of end-stage renal disease, with its annual mor-tality rate of 24 percent, has doubled every decade since 1980.2 Chronic kidney disease is 100 times more prevalent than end-stage renal disease, and its incidence is increasing at an even faster rate. Early treatment of chronic kidney disease and its complications may delay or prevent the development of end-stage renal disease. Consequently, detection of chronic kidney disease should be a priority for family physi-cians. However, data from national screen-ing programs suggest that chronic kidney disease often is not detected, even when patients have access to primary care.3,4 The Kidney Disease Outcomes Quality Initiative (KDOQI) from the National Kid-ney Foundation (NKF) has developed guide-lines for the detection and evaluation of chronic kidney disease.5,6 These guidelines define the disease and its stages and outline treatment goals for each stage. This article focuses on the detection of chronic kidney disease and the initial evaluation of affected patients